Assessment of predictive performance of caries risk assessment models based on a systematic review and meta-analysis

AI-Driven Dental Caries Management Strategies: From Clinical Practice to Professional Education and Public Self Care

Dental caries is one of the most prevalent chronic diseases among both children and adults, despite being largely preventable. This condition has significant negative impacts on human health and imposes a substantial economic burden. In recent years, scientists and dentists have increasingly started to utilize artificial intelligence (AI), particularly machine learning, to improve the efficiency of dental caries management. This study aims to provide an overview of the current knowledge about the AI-enabled approaches for dental caries management within the framework of personalized patient care. Generally, AI works as a promising tool that can be used by both dental professionals and patients. For dental professionals, it predicts the risk of dental caries by analyzing dental caries risk and protective factors, enabling to formulate personalized preventive measures. AI, especially those based on machine learning and deep learning, can also analyze images to detect signs of dental caries, assist in developing treatment plans, and help to make a risk assessment for pulp exposure during treatment. AI-powered tools can also be used to train dental students through simulations and virtual case studies, allowing them to practice and refine their clinical skills in a risk-free environment. Additionally, AI tracks brushing patterns and provides feedback to improve oral hygiene practices of the patients and the general population, thereby improving their understanding and compliance. This capability of AI can inform future research and the development of new strategies for dental caries management and control.

Development of a nomogram for root caries risk assessment in a Chinese elderly population

BACKGROUND

Root caries is a common oral disease among the elderly, and its prevalence increases year by year with the deepening of population aging. Existing caries risk assessment models do not fully consider the specific risk factors for root caries in the elderly population. This study aims to develop a predictive model for root caries risk in the elderly to facilitate early identification and personalized intervention.

METHODS

This study included 310 individuals over the age of 60. Data on oral health status, frailty level, cognitive function, and sociodemographic factors were collected through oral examinations and six questionnaires, including the Fried Frailty Phenotype, MMSE, Barthel Index, SXI, OHIP-14, and a demographic questionnaire. A root caries prediction model was constructed using multivariate logistic regression analysis, and the model's performance was evaluated using the Hosmer-Lemeshow test, ROC curves, and Decision Curve Analysis (DCA).

RESULTS

Key risk factors for root caries included age, history of coronal caries, secondary caries, use of removable partial dentures, and the number of exposed root surfaces. The nomogram model demonstrated good predictive accuracy and clinical utility in both the training cohort (AUC=0.840) and the validation cohort (AUC=0.834).

CONCLUSION

The nomogram developed in this study provides an effective tool for the early assessment of root caries risk in the elderly. Future studies should conduct larger sample and multicenter validation research. The study was retrospectively registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn/) with the registration number ChiCTR2500099297.

CLINICAL SIGNIFICANCE

This nomogram prediction model can help clinicians identify high-risk elderly patients and take early preventive measures, enhancing personalized oral health management and improving the oral health of the elderly population.

Prognostic factors and prognostic models for white spot lesions: A systematic review and meta-analysis

OBJECTIVES

To summarize the existing evidence on prognostic factors (PFs) and prognostic models (PMs) for white spot lesions (WSLs) in orthodontic patients.

SOURCES

Electronic searches were conducted across PubMed, Embase, Cochrane Library, Web of Science, and Scopus (last search date: December 19th, 2024), supplemented by grey sources (Google Scholar and ProQuest). Manual searches were performed by checking the reference lists of key relevant publications.

STUDY SELECTION

Cohort and case-control studies reporting PFs and PMs for WSLs in orthodontic patients were included. The risk of bias was assessed with QUIPS and PROBAST tools for PF and PM studies, respectively. Prognostic estimates were pooled with risk ratio (RR) using the random effects model. The certainty of the evidence was assessed with an adapted GRADE system.

DATA

Thirty-two PF and one PM studies were included, involving 5101 participants and investigating 31 PFs and 1 PM. Pretreatment lesions [RR=3.87 (95 % CI, 2.06 to 7.27)] and pretreatment oral hygiene condition [RR=1.86 (95 % CI 1.20 to 2.88)] were significant PFs for WSL incidence, whereas there is insufficient evidence for gender and treatment duration. Only 1 PM was identified, which was developed via Fisher's discriminatory analysis without adjustment and validation. The certainty of evidence was rated as very low or low.

CONCLUSIONS/CLINICAL SIGNIFICANCE

Based on low and very low certainty evidence, the existing lesions and oral hygiene condition before the commencement of orthodontic treatment are significant PFs for WSL incidence. Comprehensive pretreatment assessments are vital for preventing WSLs in orthodontic patients. The development of a novel, validated PM for WSL risk assessment is warranted.

Validating Caries Risk Assessment Tools in High-Prevalence Filipino Toddlers

INTRODUCTION AND AIMS

Caries risk assessment is an essential part of the diagnostic process. Many studies have assessed these tools, proving their effectiveness in reducing future caries risk in developed countries with low caries prevalence. However, Filipino children have consistently registered high caries prevalence rates in successive official surveys. This prospective study aimed to compare the validity of available caries risk assessment tools in predicting future caries among a high-caries-prevalent population in the Philippines.

METHODS

From the vaccination registry of community health centres in Caloocan City, Philippines, children aged 4-24 months underwent oral examinations according to modified International Caries Detection and Assessment System (ICDAS) criteria, and their primary caregivers were interviewed using a structured questionnaire. Baseline caries risk categories were evaluated using 3 available tools, without biological tests. Caries incidence was recorded during the follow-up visit after 2 years.

RESULTS

Baseline oral examinations in 703 toddlers (mean age: 13.3 months, standard deviation (SD) 2.4) revealed a high caries prevalence of 29.2%. Of the 654 eligible children without cavitated caries at baseline, 323 (mean age: 35.6 months, SD 5.1) attended the 2-year follow-up visit, with a caries incidence (cavitated and non-cavitated) of 76.5%. Caries-risk Assessment Form (CrAF) demonstrated high sensitivity but low specificity scores (93.1% and 3.9%), while Caries Management by Risk Assessment (CAMBRA) showed similar patterns (71.7% and 34.2%). Conversely, Cariogram exhibited low sensitivity but high specificity (23.5% and 80.3%).

CONCLUSION

Among CrAF, CAMBRA or Cariogram, no assessment tool came close (sensitivity + specificity < 160) to effectively identify toddlers highly at risk of caries development.

CLINICAL RELEVANCE

Current CRA tools lack sufficient accuracy in predicting caries development in high-risk populations like Filipino children. Refinement or development of more valid tools is crucial for implementing effective caries prevention strategies at both individual and population levels.

Advancing Dental Risk Profiling: A Literature Review of the Cariogram Model

The Cariogram is a well-established tool for caries risk assessment, integrating clinical, behavioral, and microbiological factors into an accessible graphical display. This review critically evaluates its performance in preventive dentistry, focusing on reliability, accuracy, and clinical value. It examines the methodological design, explores studies validating its predictive power, and compares its strengths with standard caries risk assessment methods. Additionally, the analysis highlights the tool's adaptability across diverse populations and settings while acknowledging limitations such as reliance on subjective measures and the demanding nature of data collection. Furthermore, recent studies on integrating digital technologies and artificial intelligence (AI) with the Cariogram are discussed, emphasizing their potential to enhance personalized oral healthcare. Evidence suggests that the Cariogram not only aids clinicians in planning interventions but also educates patients about their caries risk, fostering better adherence to preventive practices. Emerging research on AI-supported applications confirms the Cariogram's promise in transforming caries risk assessment by making it more practical, scalable, and accessible. This review consolidates current evidence on its role in modern dentistry and explores future directions for optimizing caries risk assessment and prevention.

THE USE OF DENTAL PATIENT-REPORTED OUTCOMES (dPROs) IN PREDICTION MODELING STUDIES IN ORAL HEALTH: A METHODOLOGICAL REVIEW

OBJECTIVE

Dental patient-reported outcomes (dPROs) are critical indicators of shared decision-making in oral healthcare. This study aimed to assess the frequency of use of dPROs and dPRO-related factors being used as predictors or predicted outcomes in clinical prediction models (CPMs) in oral health, and to identify variables associated with the use of dPROs and/or dPRO-related factors in CPMs.

METHODS

A PubMed search was conducted on 17th May, 2024, to identify eligible studies. The studies which aimed to develop CPMs in oral health using traditional statistical techniques (e.g. logistic or Cox regression) and were published from 2018 onwards were included. The dPROs and dPRO-related factors used as potential predictors, final predictors, and predicted outcomes in the CPMs were extracted and summarized. Logistic regression analyses were performed to assess the associations between various variables and the use of dPROs and dPRO-related factors.

RESULTS

A total of 144 studies were included, of which 88.2% were retrospective studies and 73.6% were on oral oncology. dPROs and/or dPRO-related factors were used as potential predictors, final predictors, and predicted outcomes in 28 (19.4%), 21 (14.6%), and 7 (4.9%) studies, respectively. The most frequently used dPRO as both potential and final predictors was self-reported orofacial pain, while the most frequently used dPRO-related factor was self-reported toothbrushing. The most frequently used dPRO as a predicted outcome was self-reported xerostomia, while no studies used dPRO-related factors as outcomes. The study topic was statistically significantly associated with the use of dPROs and/or dPRO-related factors (Odds Ratio [OR]: 9.98; 95% confidence interval [CI]: 3.36 29.67; P < .01).

CONCLUSIONS

dPROs and dPRO-related factors were infrequently used as predictors or predicted outcomes in prediction modeling studies in oral health. Studies in dental fields other than oral oncology, such as cariology and periodontology, were more likely to use dPROs and/or dPRO-related factors compared to those in oral oncology.

Prediction models for the complication incidence and survival rate of dental implants-a systematic review and critical appraisal

PURPOSE

This systematic review aims to assess the performance, methodological quality and reporting transparency in prediction models for the dental implant's complications and survival rates.

METHODS

A literature search was conducted in PubMed, Web of Science, and Embase databases. Peer-reviewed studies that developed prediction models for dental implant's complications and survival rate were included. Two reviewers independently evaluated the risk of bias and reporting quality using the PROBAST and TRIPOD guidelines. The performance of the models were also compared in this study. The review followed the PRISMA guidelines and was registered with PROSPERO (CRD42019122274).

RESULTS

The initial screening yielded 1769 publications, from which 14 studies featuring 43 models were selected. Four of the 14 studies predicted peri-implantitis as the most common outcome. Three studies predicted the marginal bone loss, two predicted suppuration of peri-implant tissue. The remaining five models predicted the implant loss, osseointergration or other complication. Common predictors included implant position, length, patient age, and a history of periodontitis. Sixteen models showed good to excellent discrimination (AUROC >0.8), but only three had undergone external validation. A significant number of models lacked model presentation. Most studies had a high or unclear risk of bias, primarily due to methodological limitation. The included studies conformed to 18-27 TRIPOD checklist items.

CONCLUSIONS

The current prediction models for dental implant complications and survival rate have limited methodological quality and external validity. There is a need for enhanced reliability, generalizability, and clinical applicability in future models.

Early childhood caries risk prediction using machine learning approaches in Bangladesh

BACKGROUND

In the last years, artificial intelligence (AI) has contributed to improving healthcare including dentistry. The objective of this study was to develop a machine learning (ML) model for early childhood caries (ECC) prediction by identifying crucial health behaviours within mother-child pairs.

METHODS

For the analysis, we utilized a representative sample of 724 mothers with children under six years in Bangladesh. The study utilized both clinical and survey data. ECC was assessed using ICDAS II criteria in the clinical examinations. Recursive Feature Elimination (RFE) and Random Forest (RF) was applied to identify the optimal subsets of features. Random forest classifier (RFC), extreme gradient boosting (XGBoost), support vector machine (SVM), adaptive boosting (AdaBoost), and multi-layer perceptron (MLP) models were used to identify the best fitted model as the predictor of ECC. SHAP and MDG-MDA plots were visualized for model interpretability and identify significant predictors.

RESULTS

The RFC model identified 10 features as the most relevant for ECC prediction obtained by RFE feature selection method. The features were: plaque score, age of child, mother's education, number of siblings, age of mother, consumption of sweet, tooth cleaning tools, child's tooth brushing frequency, helping child brushing, and use of F-toothpaste. The final ML model achieved an AUC-ROC score (0.77), accuracy (0.72), sensitivity (0.80) and F1 score (0.73) in the test set. Of the prediction model, dental plaque was the strongest predictor of ECC (MDG: 0.08, MDA: 0.10).

CONCLUSIONS

Our final ML model, integrating 10 key features, has the potential to predict ECC effectively in children under five years. Additional research is needed for validation and optimization across various groups.

Comparison of factors associated with the evidence-practice gap as perceived by Japanese and Brazilian dentists

OBJECTIVES

To identify 1) factors of the evidence-practice gap (EPG) in Japan and Brazil as perceived by dentists and compare these factors between two countries, and 2) mechanisms to close this EPG.

METHODS

The study employed a cross-sectional design by administering a web-based questionnaire to 136 Japanese and 110 Brazilian dentists. The survey queried dentists' reports of which factors possibly cause an EPG, using a newly developed 20-item questionnaire.

RESULTS

An international comparison of 20 items related to factors of the EPG between Japan and Brazil revealed that "Dentists' own experiences are sometimes given priority over evidence" and "Dentists' own thoughts are sometimes given priority over evidence" were common factors to both countries, with over 80 % agreement. In logistic regression, "Insufficient opportunity to learn about evidence in dental education at universities", "Evidence-based treatments are sometimes not covered by the dental insurance system", and "Insufficient evidence which helps dentists choose an appropriate treatment for a patient after careful consideration of his/her own background" were significantly associated with the EPG in Japan (p < 0.05). In Brazil, "Insufficient case reports in which evidence-based dentistry (EBD) is applied to clinical practice" and "Image-based information and devices used for diagnosis vary depending on individual dentists" were significantly associated with the EPG (p < 0.05).

CONCLUSIONS

This study suggests that EPG could be improved in Japan: by promoting EBD education at universities, improving the dental insurance system, and accumulating evidence according to patient background; and in Brazil: by promoting EBD case reports and standardizing diagnostic information and devices.

CLINICAL SIGNIFICANCE

Two factors of EPG common to Japan and Brazil, namely the prioritization of dentists' own "experiences" and "thoughts" over evidence, are urgent issues for improving EPG. In addition, it will be necessary to address the country-specific factors of EPG that were identified in this study.

Minimum intervention oral care: staging and grading dental carious lesions in clinical practice

Developmental staging of carious lesions is pivotal for appropriate ethical clinical decision-making in contemporary caries management. Accurate assessment of lesion extent/severity (staging) and activity (grading) allows practitioners to provide the most appropriate preventive advice and suitable interventions, enabling the implementation of evidence-based, person-focused, prevention-based, team-delivered and susceptibility-related phased minimum intervention oral care. Minimally invasive dentistry remains an important operative interventive option for cavitated lesions, but intervening at the right stage ensures patients are not started on an irreversible, destructive restorative cycle unnecessarily. This article provides an update on recommended practical methods for staging the extent/severity and grading the activity of dental carious lesions, especially for those clinical teams delivering primary care and needing to navigate remuneration systems.

Caries and white spot lesion trajectories of orthodontic patients across an observation period of 20 years

OBJECTIVES

Fixed orthodontic appliances may increase the risk for caries and white spot lesions. The aim of this retrospective study was to determine the long-term associations between both in orthodontic patients.

MATERIALS AND METHODS

103 patients aged 36.6 ± 6.5 years whose fixed appliance orthodontic treatment had finished at least 15 years ago were included. Current clinical data and photographs (T3), panoramic x-ray and photographs from before treatment (T0), after debonding (T1) and at 2-year follow-up (T2) were available. Parameters of interest were dentine caries, "Missing/Filled Teeth" (MFT), "White Spot Lesion" (WSL) index and "Periodontal Screening and Recording" index (PSR; T3 only).

RESULTS

At T0, 30.4% had no caries experience decreasing to 25.6%, 22.4% and 6.8% at T1, T2 and T3 resp. The median MFT (95% CI) at T0, T1, T2 and T3 was 2 (1;3), 3 (2;4), 3 (2;4) and 7 (6;9) resp. increasing significantly at each time point (p < 0.001 each); 30.1% had WSL at debonding. Patients with caries experience at T0 had a 2.4-fold increased risk of WSL at debonding. Dentine caries, caries experience and WSL at T1 were significantly associated with incident caries at T2, but not at T3. PSR at T3 had a significant association with previous caries incidence and WSL.

CONCLUSIONS

Caries experience prior to orthodontic treatment may constitute a risk indicator for WSL, and caries experience and WSL at its end for caries incidence in the near term.

CLINICAL RELEVANCE

Present caries and WSL may help identifying orthodontic patients with special need for prevention and counselling.

The Evidence-practice Gap in Minimal Intervention Dentistry: An International Comparison Between Dentists in Japan and Brazil

OBJECTIVES

This study was designed to: 1) evaluate and compare the evidence-practice gap (EPG) in minimal intervention dentistry (MID) in Japan and Brazil by measuring concordance between dentists' clinical practice and published evidence; and 2) identify dentists' factors associated with the EPG in both countries.

METHODS

We performed a cross-sectional study using a web-delivered questionnaire among 136 Japanese and 110 Brazilian dentists. The questionnaire consisted of three questions concerning "restoration diagnosis and treatment," "deep caries diagnosis and treatment," and "caries risk assessment" regarding MID. A chi-square test was used to analyze differences in concordance among clinical practice and evidence from the literature between Japanese and Brazilian dentists. Logistic regression analyses were performed to analyze dentists' factors associated with overall concordance for all three questions.

RESULTS

Overall concordance was significantly higher in Brazil (55%) than in Japan (38%) (p<0.01). Concerning how evidence was obtained, textbooks, nonacademic journals, and seminars and workshops were used as information sources more frequently by Japanese than Brazilian dentists (p<0.001), whereas scientific journal articles in English were used more frequently by Brazilian dentists (p<0.001). On logistic regression analysis, overall concordance was higher for Japanese dentists who frequently obtained evidence from scientific journal articles in English (p<0.05), whereas Brazilian dentists who frequently obtained evidence from the Internet were associated with lower overall concordance (p<0.05).

CONCLUSIONS

Because overall concordance was significantly higher in Brazil than in Japan, Japan may have a greater EPG in MID practice. Specific characteristics of Japanese and Brazilian dentists showed significant associations with overall concordance.

Application of omics technologies in cariology research: A critical review with bibliometric analysis

OBJECTIVES

To review the application of omics technologies in the field of cariology research and provide critical insights into the emerging opportunities and challenges.

DATA & SOURCES

Publications on the application of omics technologies in cariology research up to December 2022 were sourced from online databases, including PubMed, Web of Science and Scopus. Two independent reviewers assessed the relevance of the publications to the objective of this review.

STUDY SELECTION

Studies that employed omics technologies to investigate dental caries were selected from the initial pool of identified publications. A total of 922 publications with one or more omics technologies adopted were included for comprehensive bibliographic analysis. (Meta)genomics (676/922, 73 %) is the predominant omics technology applied for cariology research in the included studies. Other applied omics technologies are metabolomics (108/922, 12 %), proteomics (105/922, 11 %), and transcriptomics (76/922, 8 %).

CONCLUSION

This study identified an emerging trend in the application of multiple omics technologies in cariology research. Omics technologies possess significant potential in developing strategies for the detection, staging evaluation, risk assessment, prevention, and management of dental caries. Despite the numerous challenges that lie ahead, the integration of multi-omics data obtained from individual biological samples, in conjunction with artificial intelligence technology, may offer potential avenues for further exploration in caries research.

CLINICAL SIGNIFICANCE

This review presented a comprehensive overview of the application of omics technologies in cariology research and discussed the advantages and challenges of using these methods to detect, assess, predict, prevent, and treat dental caries. It contributes to steering research for improved understanding of dental caries and advancing clinical translation of cariology research outcomes.

Multivariable prediction models of caries increment: a systematic review and critical appraisal

BACKGROUND

Multivariable prediction models are used in oral health care to identify individuals with an increased likelihood of caries increment. The outcomes of the models should help to manage individualized interventions and to determine the periodicity of service. The objective was to review and critically appraise studies of multivariable prediction models of caries increment.

METHODS

Longitudinal studies that developed or validated prediction models of caries and expressed caries increment as a function of at least three predictors were included. PubMed, Cochrane Library, and Web of Science supplemented with reference lists of included studies were searched. Two reviewers independently extracted data using CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) and assessed risk of bias and concern regarding applicability using PROBAST (Prediction model Risk Of Bias ASessment Tool). Predictors were analysed and model performance was recalculated as estimated positive (LR +) and negative likelihood ratios (LR -) based on sensitivity and specificity presented in the studies included.

RESULTS

Among the 765 reports identified, 21 studies providing 66 prediction models fulfilled the inclusion criteria. Over 150 candidate predictors were considered, and 31 predictors remained in studies of final developmental models: caries experience, mutans streptococci in saliva, fluoride supplements, and visible dental plaque being the most common predictors. Predictive performances varied, providing LR + and LR - ranges of 0.78-10.3 and 0.0-1.1, respectively. Only four models of coronal caries and one root caries model scored LR + values of at least 5. All studies were assessed as having high risk of bias, generally due to insufficient number of outcomes in relation to candidate predictors and considerable uncertainty regarding predictor thresholds and measurements. Concern regarding applicability was low overall.

CONCLUSIONS

The review calls attention to several methodological deficiencies and the significant heterogeneity observed across the studies ruled out meta-analyses. Flawed or distorted study estimates lead to uncertainty about the prediction, which limits the models' usefulness in clinical decision-making. The modest performance of most models implies that alternative predictors should be considered, such as bacteria with acid tolerant properties.

TRIAL REGISTRATION

PROSPERO CRD#152,467 April 28, 2020.

Survival Rate of Atraumatic Restorative Treatment Restorations in Primary Posterior Teeth in Children with High Risk of Caries in the Republic of Kosovo-1-Year Follow-up

OBJECTIVE

 Atraumatic restorative treatment (ART) may be beneficial for disadvantaged populations with no or limited access to dental services. This study aimed to evaluate the survival rate of single-surface ART restorations in primary posterior teeth in children with high caries risk.

MATERIALS AND METHODS

 This study was conducted in six rural areas of the Republic of Kosovo, and 100 children aged 3 to 8 years participated in the study. Information was obtained from each parent/guardian regarding their children, such as sociodemographic characteristics, general health, dental history, dietary habits, oral hygiene, and fluoride exposure. The reduced Cariogram was used to estimate the risk of caries in the participants based on the seven factors specified in the program, and all the provided information were collected and entered in a computer program of the Cariogram. A pediatric dentist, accompanied by two assistants, performed 100 ART restorations in school settings using high-viscosity glass-ionomer cement (Fuji IX) following the nine steps of the ART procedure. The restorations were evaluated at 3, 6, 9, and 12 months using the ART restoration criteria.

STATISTICAL ANALYSIS

 Percentages, mean value, standard deviation, mean interquartile range, and difference test between arithmetic mean values were used to analyze the research results.

RESULTS

 Review of the average of reduced Cariogram showed that the majority of children, 72%, were at high risk of developing caries, with only 28% having a good chance of avoiding caries in the future. A total of 77% of the children in the study had never visited dentists before due to poor economic conditions and the lack of dentists in the area. The success rates of ART restorations performed in single-surface cavities in primary teeth were very encouraging, with more than 97% success rates after a 1-year follow-up period.

CONCLUSION

 Our results demonstrate that ART is efficient, affordable, and practical for the treatment of single-surface cavities in primary posterior teeth. Owing to its low price and atraumatic nature, ART can potentially help disadvantaged children in Kosovo access dental care.

Assessing Adherence to Provider's Recommendations in Caries Risk Assessment and Management: A Retrospective Data Review

AIM

To evaluate the distribution of caries risk category of patients at a dental institution and determine adherence to providers' recommendations.

MATERIALS AND METHODS

A cross-sectional retrospective review of 1,235 patients records that included data collection on demographics, the sum of the number of decayed, missing due to caries, and filled teeth in the permanent teeth (DMFT), presence of frequent snacking, stimulated salivary flow rate, stimulated saliva pH, saliva buffering capacity, biofilm activity, caries risk category, anti-caries prescription accept/decline, and change in the caries risk category. Statistical analysis was carried out through Pearson's Chi-squared test and linear model ANOVA with a significance level of 0.05.

RESULTS

Pearson's Chi-squared test showed a statistically significant difference in frequency by risk category (p < 0.001) indicating that patients were skewed toward high and extreme caries risk. Linear model ANOVA showed that higher risk categories were associated with lower salivary flow rates (p = 0.010) and higher biofilm activity (p < 0.001). About, 1 out of 3 patients were reported to have frequent snacking (N = 391, 32%). Frequent snacking patients were more likely to present with higher caries risk assessment (p < 0.001), younger age (p < 0.001), and female (p < 0.001). Despite recommendations from the dental student provider, only 27% accepted the anti-cavity prescriptions while 61% declined the recommendation.

CONCLUSION

Distribution of caries risk category is not evenly distributed, but rather skewed toward high and extreme caries risk levels. Despite the identified risks, there is low adherence to the recommendations provided by healthcare providers. The results underscore the necessity for targeted interventions and initiatives aimed at fostering behavioral changes to enhance oral health outcomes.

CLINICAL SIGNIFICANCE

There is a high need for targeted interventions and initiatives that promote behavioral changes to enhance oral health outcomes.

A mixed methods approach to obtaining health care provider feedback for the development of a Canadian pediatric dental caries risk assessment tool for children <6 years

Introduction

Early childhood caries (ECC) is a chronic but preventable disease affecting young children worldwide. Many young children face access to care barriers to early preventive dental visits for a variety of reasons, which can increase their risk for ECC. Non-dental primary health care providers are well positioned to assist in assessing a child's risk for ECC by performing caries risk assessment (CRA). The purpose of this project was to report on primary health care provider and stakeholder feedback in order to refine a drafted CRA tool for Canadian children &lt;6 years of age intended for use by non-dental primary health care providers.

Methods

In this mixed methods project, we conducted six focus groups with primarily non-dental primary health care providers followed by a short paper-based survey to quantify preferences and feedback. Data were thematically and descriptively analyzed.

Results

Participants’ feedback on the drafted CRA tool included the need for it to be relatively quick to complete, easy and practical to score, easy to implement into practitioners’ clinic schedules, and to include anticipatory guidance information to share with parents and caregivers. All participants (100%) welcomed a CRA tool. Many (85.4%) liked a layout that could be added to tools they already utilize. Most (73.2%) wanted the tool to be in colour, and many (90.2%) wanted the tool to include pictures.

Conclusion

Non-dental primary health care providers informed the final development and layout of the newly released Canadian CRA tool. Their feedback resulted in a user-friendly CRA tool with provider-patient dynamics and preferences.

Clinical practice guideline adaptation for risk-based caries management in 18-55 year-old Iranian adults

PURPOSE

To adapt an evidence-based clinical practice guideline (CPG) for risk-based management of caries in 18-55 year-old Iranian adults.

METHODS

A multidisciplinary adaptation team reviewed evidence-based guidelines such as the NICE, SIGN, and ADA according to the defined clinical questions. In addition, databases such as the PubMed and Google Scholar were searched and CPGs were screened and appraised using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) tool. Clinical scenarios were developed and their level of evidence, clinical advantage and adaptability were assessed. Following a two-round ranking by experts, the final recommendations were selected using the RAND-UCLA appropriateness method.

RESULTS

Of 17 CPGs, 5 were selected as the source guidelines for adaptation. To assess the risk of caries in the adult population, reduced Cariogram (without saliva tests) and CAMBRA were suggested as diagnostic tools. In addition, 53 risk-based recommendations on the preventive care (including the use of fluoride toothpaste, fluoride, and chlorhexidine mouthwash, at home and in-office fluoride gel, fluoride varnish, mouth buffering, and sealant), operative intervention threshold, and follow-up interval were adapted for Iranian adults.

CONCLUSIONS

A guideline was adapted for risk-based management of dental caries in Iranian adults. This helps local dentists in decision making and promoting oral health of adults. Further research is needed to assess the external validity and feasibility of the adapted guideline in the Iranian population.

Application of a Caries Treatment Difficulty Assessment System in Dental Caries Management

Dental caries is one of the most common chronic diseases caused by progressive bacteria, affecting all age groups. Today, restorative fillings are widely used for dental caries treatment, but the restorative treatment has a high failure rate. Meanwhile, many researchers have discovered the differences of caries risk among populations by using the caries risk assessment and put forward a new standpoint that caries should be treated individually. Therefore, our research group established a Dental Caries Treatment Difficulty Assessment system in a previous study. This time, we combined the caries risk assessment with the caries treatment difficulty assessment, then used Python to design a Dental Caries Management Software. The purpose of this case report is to present a case applying this software in dental caries management and other data collected in Chengdu, China, with this software on the assessment of caries treatment difficulty. Patients with personalized assessment and management can achieve good treatment results, including reducing the risk and treatment difficulty of dental caries. At the same time, other cases show that the software has good application potential in individual management and group information collection. These cases indicate that the software enables dentists to carry out both the risk assessments and the treatment difficulty assessment of patients, and it has the potential as a tool for epidemiological investigation. It also enables dentists and patients to have a basic understanding of the dental health status of patients and create personalized dental caries treatment, so as to achieve the goal of controlling the progression of dental caries and rebuilding the structure and restoring the function of teeth.

Establishing risk-based recall interval for caries management among 11-12-year-old Pakistani children

Background

This study aims to investigate the rate of caries increment among 11-12-year-old Pakistani children over 18 months using modified International Caries Detection and Assessment Systems II (ICDAS) and subsequently establish an appropriate dental recall interval for our targeted population according to their caries risk intensity.

Methods

A prospective longitudinal study was conducted in Bhakkar, Punjab, Pakistan. The 226 children from seven schools of Bhakkar with the highest student enrolment were conveniently selected. Caries risk assessment was performed using a computer-based reduced Cariogram program. Caries increment among cavitated lesions was measured by modified Beck's method or adjusted caries increment. Two ICDAS II cutoffs were created for the analysis of cavitated lesion (ICDAS code 3–6) and cavitated plus non-cavitated lesion (ICDAS code A-6).

Results

At the risk assessment stage, 39.8% of the children were classified as low risk, 30.5% as medium risk, and 29.7% as high risk. Caries increment at both cutoff points increased with caries risk at all follow-ups. The highest caries increment was recorded at the third follow-up among high-risk children at cutoff 3–6 (1.95 ± 3.18) and A-6 (4.01 ± 4.31). However, the lowest caries increment was recorded at the third follow-up among low-risk children at cutoff 3–6 (0.18 ± 1.42) and A-6 (1.11 ± 3.33).

Conclusion

Based on the study findings for Pakistani children with cavitated lesions, the recommended risk-based recall interval for caries management is 18 months for those with low and medium caries risk and six months for those with high caries risk. On the other hand, recommendations for risk-based recall intervals for caries management in non-cavitated and cavitated lesions are six months for low-risk, moderate risk and high-risk for Pakistani 11-12-year-old children.

Expert consensus on early childhood caries management

Early childhood caries (ECC) is a significant chronic disease of childhood and a rising public health burden worldwide. ECC may cause a higher risk of new caries lesions in both primary and permanent dentition, affecting lifelong oral health. The occurrence of ECC has been closely related to the core microbiome change in the oral cavity, which may be influenced by diet habits, oral health management, fluoride use, and dental manipulations. So, it is essential to improve parental oral health and awareness of health care, to establish a dental home at the early stage of childhood, and make an individualized caries management plan. Dental interventions according to the minimally invasive concept should be carried out to treat dental caries. This expert consensus mainly discusses the etiology of ECC, caries-risk assessment of children, prevention and treatment plan of ECC, aiming to achieve lifelong oral health.

Caries risk assessment using different Cariogram models. A comparative study about concordance in different populations—Adults and children

This methodological survey aimed to verify whether there is concordance among several Cariogram different risk models at different thresholds, comparing both children and adult populations and how each risk/protective factor weight on the overall caries risk profile. Three groups’ data (two in children and one in adults) were obtained from previous studies, while a fourth, in young adults, was ad hoc enrolled. Different caries risk levels were assessed: a) three risk categories with two different thresholds as: “low risk”  =  61–100% or 81–100% chance to avoid caries, “moderate risk”  =  41–60% or 21–80% and “high risk”  =  0–40% or 0–20%, named model 1 and 2; b) four risk categories with two different thresholds as: “low risk”  =  61–100% or 76–100%, “moderate/low risk” = 41–60% or 51–75%; “moderate/high risk” = 21–40% or 26–50% and “high risk” = 0–20% or 0–25%, model 3 and 4; c) five risk categories as: “very low risk”  =  81–100%; “low risk”  =  61–80% “moderate risk” = 41–60%; “high risk” = 21–40% and “very high risk” = 0–20%, model 5. Concordance of the different Cariogram risk categories among the four groups was calculated using Cohen’s kappa. The weight of the association between all Cariogram models toward the Cariogram risk variables was evaluated by ordinal logistic regression models. Considering Cariogram model 1 and 2, Cohen’s Kappa values ranged from 0.40 (SE = 0.07) for the young adult group to 0.71 (SE = 0.05) for the adult one. Cohen’s Kappa values ranged from 0.14 (SE = 0.03 p<0.01) for the adult group to 0.62 (SE = 0.02) for the two groups of children in models 3 and 4. Statistically significant associations were found for all Cariogram risk variables excepting Fluoride program in models 4 and 5 and the overall risk on children’s samples. Caries experience showed a quite variable weight in the different models in both adult groups. In the regression analyses, adult groups’ convergence was not always achievable since variations in associations between caries risk and different risk variables were narrower compared to other samples. Significant differences in caries risk stratification using different thresholds stands out from data analysis; consequently, risk assessments need to be carefully considered due to the risk of misleadingly choosing preventive and research actions.

Using the Prediction Model Risk of Bias Assessment Tool (PROBAST) to Evaluate Melanoma Prediction Studies

Simple Summary

The rising incidence of cutaneous melanoma over recent decades, combined with a general interest in cancer risk prediction, has led to a high number of published melanoma risk prediction models. The aim of our work was to assess the validity of these models in order to discuss the current state of knowledge about how to predict incident cutaneous melanoma. To assess the risk of bias, we used a standardized procedure based on PROBAST (Prediction model Risk Of Bias ASsessment Tool). Only one of the 42 studies identified was rated as having a low risk of bias. However, it was encouraging to observe a recent reduction of problematic statistical methods used in the analyses. Nevertheless, the evidence base of high-quality studies that can be used to draw conclusions on the prediction of incident cutaneous melanoma is currently much weaker than the high number of studies on this topic would suggest.

Abstract

Rising incidences of cutaneous melanoma have fueled the development of statistical models that predict individual melanoma risk. Our aim was to assess the validity of published prediction models for incident cutaneous melanoma using a standardized procedure based on PROBAST (Prediction model Risk Of Bias ASsessment Tool). We included studies that were identified by a recent systematic review and updated the literature search to ensure that our PROBAST rating included all relevant studies. Six reviewers assessed the risk of bias (ROB) for each study using the published “PROBAST Assessment Form” that consists of four domains and an overall ROB rating. We further examined a temporal effect regarding changes in overall and domain-specific ROB rating distributions. Altogether, 42 studies were assessed, of which the vast majority (n = 34; 81%) was rated as having high ROB. Only one study was judged as having low ROB. The main reasons for high ROB ratings were the use of hospital controls in case-control studies and the omission of any validation of prediction models. However, our temporal analysis results showed a significant reduction in the number of studies with high ROB for the domain “analysis”. Nevertheless, the evidence base of high-quality studies that can be used to draw conclusions on the prediction of incident cutaneous melanoma is currently much weaker than the high number of studies on this topic would suggest.

Precision dentistry—what it is, where it fails (yet), and how to get there

Objectives

Dentistry is stuck between the one-size-fits-all approach towards diagnostics and therapy employed for a century and the era of stratified medicine. The present review presents the concept of precision dentistry, i.e., the next step beyond stratification into risk groups, and lays out where we stand, but also what challenges we have ahead for precision dentistry to come true.

Material and methods

Narrative literature review.

Results

Current approaches for enabling more precise diagnostics and therapies focus on stratification of individuals using clinical or social risk factors or indicators. Most research in dentistry does not focus on predictions — the key for precision dentistry — but on associations. We critically discuss why both approaches (focus on a limited number of risk factors or indicators and on associations) are insufficient and elaborate on what we think may allow to overcome the status quo.

Conclusions

Leveraging more diverse and broad data stemming from routine or unusual sources via advanced data analytics and testing the resulting prediction models rigorously may allow further steps towards more precise oral and dental care.

Clinical significance

Precision dentistry refers to tailoring diagnostics and therapy to an individual; it builds on modelling, prediction making and rigorous testing. Most studies in the dental domain focus on showing associations, and do not attempt to make any predictions. Moreover, the datasets used are narrow and usually collected purposively following a clinical reasoning. Opening routine data silos and involving uncommon data sources to harvest broad data and leverage them using advanced analytics could facilitate precision dentistry.